Healthcare Provider Details

I. General information

NPI: 1851422836
Provider Name (Legal Business Name): HAVEN INNERHEALING MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 BRIAR CREEK CIR
GARLAND TX
75044-6857
US

IV. Provider business mailing address

1816 BRIAR CREEK CIR
GARLAND TX
75044-6857
US

V. Phone/Fax

Practice location:
  • Phone: 972-495-6880
  • Fax: 972-495-6880
Mailing address:
  • Phone: 972-495-6880
  • Fax: 972-495-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberME74784
License Number StateTX

VIII. Authorized Official

Name: MR. LARRY MEADOWS
Title or Position: PRESIDENT
Credential: M.S.
Phone: 972-495-6880